Publications by authors named "Sana Ahmed"

30 Publications

  • Page 1 of 1

Effect of gender and clinical-financial vulnerability on mental distress due to COVID-19.

Arch Womens Ment Health 2020 12 9;23(6):775-777. Epub 2021 Jan 9.

National Institute of Mental Health and Neurosciences, Bengaluru, India.

The COVID-19 pandemic has had an enormous impact on people's mental health. This study examines whether gender influences the mental distress in people from at-risk populations (clinically high risk and financially vulnerable). A cross-sectional survey was administered between the 23rd and 28th of April 2020 to 15,691 individuals from 32,596 households in the UK. Our findings confirmed that individuals who are clinically high risk or financially vulnerable or a combination of both experience significantly higher levels of mental distress. Additionally, we also found that females experienced higher levels of mental distress than males across various categories.
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http://dx.doi.org/10.1007/s00737-020-01097-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794077PMC
December 2020

Chorionic Bump: Radiologic Features and Pregnancy Outcomes.

Cureus 2020 Nov 14;12(11):e11480. Epub 2020 Nov 14.

Women's Radiology, Women's Wellness and Research Center, Clinical Imaging, Hamad Medical Corporation, Doha, QAT.

Background Chorionic bump is a rare condition defined as a bulge or protrusion from the choriodecidual surface into the gestational sac. The limited literature on this infrequent entity suggests that the pregnancies with multiple chorionic bumps mostly result in fetal demise. Aims To review the available literature and the patients from our institute having sonographic findings of chorionic bump and making the sonographers and radiologists aware of this known cause of first-trimester pregnancy loss. Study design A retrospective review of the cases diagnosed at our institute during the last four years. Methods and materials Single-center institutional data for four years (January 2016-December 2019) was accessed using ICD codes. IRB approval was waived owing to the anonymized use of patient data. Results Six female patients diagnosed with chorionic bump were included, with a mean age of 29.83±12 years. The average gestational age at the time of diagnosis was 8.16±3 weeks. The most common sonographic findings were a protrusion from the chorionic wall into the gestational sac cavity, having a central hypoechoic region with peripheral hyperechoic rim (isoechoic to the chorion) and having no vascularity (n=5), and the less common finding was a hyperechoic protrusion with no vascularity (n=1). n=5 had a single lesion, and n=1 had two lesions. The average diameter of the lesion in the largest dimension was 18±11 mm. n=3 pregnancies resulted in a first-trimester miscarriage, and n=3 pregnancies delivered healthy babies at term.  Conclusions A chorionic bump significantly increases the risk of a first-trimester miscarriage.
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http://dx.doi.org/10.7759/cureus.11480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735167PMC
November 2020

Prevalence of Nocturnal Enuresis Among Children Dwelling in Rural Areas of Sindh.

Cureus 2020 Aug 6;12(8):e9590. Epub 2020 Aug 6.

Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK.

Introduction Nocturnal enuresis (NE) is usually a condition of childhood and refers to involuntary urinary incontinence during sleep. Due to its impact on a child's mental and social health, it is important to determine the prevalence of this condition among a population. Therefore, the aim of our study is to evaluate its prevalence and associated risk factors among children living in rural areas of Sindh province, Pakistan. Methods Fifteen-hundred children aged between three and 12 years of age who lived in rural areas of Sindh and visited a tertiary care hospital for various complaints were selected at random. Their parents were asked to fill in a questionnaire regarding the symptoms and risk factors of NE. The data were gathered over a period of three months, starting from June 2019 to August 2019. The data were then analyzed to draw associations between the findings. Results Out of the total 1500 participants, 570 (38%) were male and the remaining 930 (62%) were female. Among these, the majority with NE were males (70%) and children between the age of six and seven years (65%). The first and fourth to fifth born were more likely to develop symptoms of NE. There was also a positive association between family history (P=0.003), delayed milestones (0.001), psychological problems (0.005), and urinary tract infection (P=0.001). However, a child suffering from chronic illness, parasitic infection, or anemia did not have a significant relationship with developing NE. Conclusion The total prevalence of NE among rural areas was 40%, which was higher than in urban areas. This could be due to limited awareness among parents and limited healthcare facilities to manage the condition in rural areas. However, it is important to identify the symptoms of NE earlier among children to reduce the impact it leaves on them.
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http://dx.doi.org/10.7759/cureus.9590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478510PMC
August 2020

Anhydrous Ammonia Chemical Release - Lake County, Illinois, April 2019.

MMWR Morb Mortal Wkly Rep 2020 Jan 31;69(4):109-113. Epub 2020 Jan 31.

On April 25, 2019, a farm tractor towing two 2-ton ammonia tanks on a county road in Lake County, Illinois, experienced a mechanical failure that resulted in the release of anhydrous ammonia, a colorless, pungent, irritating gas that can cause severe respiratory and ocular damage (1). Approximately 80% of anhydrous ammonia produced in the United States is used as a fertilizer in agriculture (1). Eighty-three persons, including first responders, motorists, and neighborhood residents, were evaluated at area hospitals because of exposure to the gas. Two weeks after the release, the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC's National Center for Environmental Health (NCEH) collaborated with the Lake County Health Department and the Illinois Department of Public Health on an investigation using ATSDR's Assessment of Chemical Exposures program to describe the release, review the emergency response, and determine health effects associated with the exposure. First responders, community residents, and hospital personnel reported communication challenges related to the nature of the gas release and effective protective measures. Among the 83 persons evaluated at six area hospitals for effects of the chemical release, 14 (17%) were hospitalized, including eight (10%) who were admitted to the intensive care unit (ICU), seven (8%) of whom required endotracheal intubation and mechanical ventilation; no deaths occurred. In addition, ICU health care providers experienced symptoms of secondary exposure. The National Institute for Occupational Safety and Health's Emergency Responder Health Monitoring and Surveillance Program has specific recommendations and tools to protect responders during all phases of a response (2). Hospitals also need to review institutional policies and procedures for chemical mass casualty events, including decontamination (3). Prompt and correct identification of hazardous material (hazmat) events, and clear communication among responding entities, including on-scene and hospital responders, is important to ensure effective response after a chemical release.
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http://dx.doi.org/10.15585/mmwr.mm6904a4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004403PMC
January 2020

Knowledge, Attitudes, and Barriers Toward Research Among Medical Students of Karachi.

Cureus 2019 Sep 9;11(9):e5599. Epub 2019 Sep 9.

Internal Medicine, University Hospital Kerry, Tralee, IRL.

Introduction Our study was meant to assess the knowledge, attitude, and barriers towards research in medical students of Pakistan. By assessing the factors, we aim to increase the role of medical students in research, which will eventually help developing countries like Pakistan to achieve self-reliance in health care. Methods Undergraduate and postgraduate students of medicine, dentistry, and pharmacy schools of Dow University of Health Sciences, Karachi, were enrolled from February-March 2018 in a cross-sectional, descriptive study using questionnaires to provide details of the parameters of attitude to the knowledge of and barriers towards research for each individual. All data were coded for each of the parameters. Data analyses were performed by one-way analysis of variance (ANOVA)/Tukey and Student's t-test, Pearson's correlation, and Chi-squared tests. Results A total of 850 questionnaires were received. The overall mean scores of students on attitude, knowledge, and barriers were 69.27 ± 13.44, 70.39 ± 15.67, and 72.46 ± 13.46, respectively; 81.8% of students' scores fell above the middle of the maximum score for knowledge, but 84.5% of attitude scores came in at below the middle of the maximum score. Undergraduate students had a more positive attitude to research than postgraduate students (69.20 ± 11.10 vs 64.23 ± 10.98; p = 0.002). Male students had a better attitude than females (72.97 ± 20.54 vs 67.09 ± 21.56; p = 0.010). Barriers highlighted by students most significantly included a lack of funding support and preference for instruction over research. Conclusion Students showed good knowledge of research, but their attitude was not up to the mark. The barriers highlighted suggest a need for a change in the strategies for research. Attention should be paid to inculcate research as part of the student curriculum and to make available incentives, information, and mentors to solve the problems most students face in the field of research.
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http://dx.doi.org/10.7759/cureus.5599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822902PMC
September 2019

Cytosolic delivery of quantum dots mediated by freezing and hydrophobic polyampholytes in RAW 264.7 cells.

J Mater Chem B 2019 12 7;7(46):7387-7395. Epub 2019 Nov 7.

School of Materials Science, Japan Advanced Institute of Science and Technology (JAIST), Nomi, Ishikawa 923-1292, Japan.

Quantum dots (QDs) can be delivered efficiently inside macrophages using a freeze-concentration approach. In this study, we introduced a new, facile, high concentration-based freezing technology of low toxicity. We also developed QD-conjugated new hydrophobic polyampholytes using poly-l-lysine (PLL), a naturally derived polymer, which showed sustained biocompatibility, stability over one week, and enhanced intracellular delivery. When freeze-concentration was applied, the QD-encapsulated hydrophobic polyampholytes showed a higher tendency to adsorb onto the cell membrane than the non-frozen molecules. Interestingly, we observed that the efficacy of adsorption of QDs on RAW 264.7 macrophages was higher than that on fibroblasts. Furthermore, the intracellular delivery of QDs using hydrophobic polyampholytes was higher than those of PLL and QDs. In vitro studies revealed the efficient endosomal escape of QDs in the presence of hydrophobic polyampholytes and freeze-concentration. Collectively, these observations indicated that the promising combination of freeze-concentration and hydrophobic polyampholytes may act as an effective and versatile strategy for the intracellular delivery of QDs, which can be used for biological diagnosis and therapeutic applications.
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http://dx.doi.org/10.1039/c9tb01184fDOI Listing
December 2019

Sagliker syndrome in a patient with end-stage renal disease with secondary hyperparathyroidism.

Proc (Bayl Univ Med Cent) 2019 Oct 15;32(4):624-626. Epub 2019 Jul 15.

Division of Nephrology, Department of Internal Medicine, Baylor University Medical Center at DallasDallasTexas.

Sagliker syndrome (SS), also known as an "uglifying human face syndrome," is one of the severe manifestations of chronic kidney disease in patients with uncontrolled secondary hyperparathyroidism. Patients with SS develop short stature, maxillary and mandibular bone overgrowth, nasal bone and cartilage destruction, widely spaced teeth with anterior positioning, soft tissue tumors in the oral cavity, auditory loss, and neurological and psychological features. SS can possibly be prevented with proper treatment of secondary hyperparathyroidism using disease-modifying medication and surgical therapies. We report a case of SS in a patient in the USA with end-stage renal disease achieving adequate hemodialysis.
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http://dx.doi.org/10.1080/08998280.2019.1624092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6793963PMC
October 2019

Early Impact of 13-Valent Pneumococcal Conjugate Vaccine Use on Invasive Pneumococcal Disease Among Adults With and Without Underlying Medical Conditions-United States.

Clin Infect Dis 2020 06;70(12):2484-2492

Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: The 13-valent pneumococcal vaccine (PCV13) was introduced for US children in 2010 and for immunocompromised adults ≥19 years old in series with the 23-valent polysaccharide vaccine (PPSV23) in 2012. We evaluated PCV13 indirect effects on invasive pneumococcal disease (IPD) among adults with and without PCV13 indications.

Methods: Using Active Bacterial Core surveillance and the National Health Survey, using Active Bacterial Core surveillance and the National Health Interview Survey, we estimated and compared IPD incidence in 2013-2014 and 2007-2008, by age and serotype group (PCV13, PPSV23-unique, or nonvaccine types [NVTs]), among adults with and without PCV13 indications.

Results: IPD incidence declined among all adults. Among adults 19-64 years, PCV13-type IPD declined 57% (95% confidence interval [CI], -68% to -43%) in adults with immunocompromising conditions (indication for PCV13 use), 57% (95% CI, -62% to -52%) in immunocompetent adults with chronic medical conditions (CMCs, indications for PPSV23 use alone), and 74% (95% CI, -78% to -70%) in adults with neither vaccine indication. Among adults aged ≥65 years, PCV13-type IPD decreased 68% (95% CI, -76% to -60%) in those with immunocompromising conditions, 68% (95% CI, -72% to -63%) in those with CMCs, and 71% (95% CI, -77% to -64%) in healthy adults. PPSV23-unique types increased in adults 19‒64 years with CMCs, and NVTs did not change among adults with or without PCV13 indications. From 2013 to 2014, non-PCV13 serotypes accounted for 80% of IPD.

Conclusions: IPD incidence among US adults declined after PCV13 introduction in children. Similar reductions in PCV13-type IPD in those with and without PCV13 indications suggest that observed benefits are largely due to indirect effects from pediatric PCV13 use rather than direct use among adults.
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http://dx.doi.org/10.1093/cid/ciz739DOI Listing
June 2020

The Role of Wound Care in 2 Group A Streptococcal Outbreaks in a Chicago Skilled Nursing Facility, 2015‒2016.

Open Forum Infect Dis 2018 Jul 26;5(7):ofy145. Epub 2018 Jun 26.

Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Two consecutive outbreaks of group A (GAS) infections occurred from 2015-2016 among residents of a Chicago skilled nursing facility. Evaluation of wound care practices proved crucial for identifying transmission factors and implementing prevention measures. We demonstrated shedding of GAS on settle plates during care of a colonized wound.
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http://dx.doi.org/10.1093/ofid/ofy145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334819PMC
July 2018

The Burden of Caring for a Child or Adolescent With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): An Observational Longitudinal Study.

J Clin Psychiatry 2018 12 11;80(1). Epub 2018 Dec 11.

Pediatric Divisions of Child & Adolescent Psychiatry, Stanford University School of Medicine, Palo Alto, California, USA.

Objective: To describe the longitudinal association between disease severity, time established in clinical treatment, and caregiver burden in a community-based patient population diagnosed with pediatric acute-onset neuropsychiatric syndrome (PANS).

Methods: The study included an observational longitudinal cohort design, with Caregiver Burden Inventories (CBIs) collected between April 2013 and November 2016 at the Stanford PANS multidisciplinary clinic. Inclusion criteria for this study were as follows: pediatric patients meeting strict PANS/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) diagnostic criteria (n = 187), having a caregiver fill out at least 1 complete CBI during a disease flare (n = 114); and having family who lives locally (n = 97). For longitudinal analyses, only patients whose caregiver had filled out 2 or more CBIs (n = 94 with 892 CBIs) were included. In the study sample, most primary caregivers were mothers (69 [71.1%] of 97), the majority of PANS patients were male (58 [59.8%] of 97), and mean age at PANS onset was 8.8 years.

Results: In a patient's first flare tracked by the clinic, 50% of caregivers exceeded the caregiver burden score threshold used to determine respite need in care receiver adult populations. Longitudinally, flares, compared with quiescence, predicted increases in mean CBI score (6.6 points; 95% CI, 5.1 to 8.0). Each year established in clinic predicted decreased CBI score (-3.5 points per year; 95% CI, -2.3 to -4.6). Also, shorter time between PANS onset and entry into the multidisciplinary clinic predicted greater improvement in mean CBI score over time (0.7 points per year squared; 95% CI, 0.1 to 1.3). Time between PANS onset and treatment with antibiotics or immunomodulation did not moderate the relationship between CBI score and time in clinic.

Conclusions: PANS caregivers suffer high caregiver burden. Neuropsychiatric disease severity predicts increased caregiver burden. Caregiver burden tends to decrease over time in a group of patients undergoing clinical treatment at a specialty PANS clinic. This decrease could be independent of clinical treatment.
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http://dx.doi.org/10.4088/JCP.17m12091DOI Listing
December 2018

pH-Responsive Polyion Complex Vesicle with Polyphosphobetaine Shells.

Langmuir 2019 02 11;35(5):1249-1256. Epub 2018 Jul 11.

Department of Applied Chemistry, Graduate School of Engineering , University of Hyogo , 2167 Shosha , Himeji , Hyogo 671-2280 , Japan.

When a bioactive molecule is taken into cells by endocytosis, it is sometimes unable to escape from the lysosomes, resulting in inefficient drug release. We prepared pH-responsive polyion complex (PIC) vesicles that collapse under acidic conditions such as those inside a lysosome. Furthermore, under acidic conditions, cationic polymer was released from the PIC vesicles to break the lysosome membranes. Diblock copolymers (PM and PA) consisting of water-soluble zwitterionic poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) block and cationic or anionic blocks were synthesized via reversible addition-fragmentation chain transfer (RAFT) radical polymerization. Poly(3-(methacrylamidopropyl) trimethylammonium chloride) (PMAPTAC) and poly(sodium 6-acrylamidohexanoate) (PAaH) were used as the cationic and anionic blocks, respectively. The pendant hexanoate groups in the PAaH block are ionized in basic water and in phosphate buffered saline (PBS), while the hexanoate groups are protonated in acidic water. In basic water, PIC vesicles were formed from a charge neutralized mixture of oppositely charged diblock copolymers. At the interface of PIC vesicle and water exists biocompatible PMPC shells. Under acidic conditions, the PIC vesicles collapsed, because the charge balance shifted due to protonation of the PAaH block. After collapse of the PIC vesicles, PA formed micelles composed of protonated PAaH core and PMPC shells, while PM was released as unimers. PIC vesicles can encapsulate hydrophilic nonionic guest molecules into their hollow core. Under acidic conditions, the PIC vesicles can release the guest molecules and PM. The cationic PM can break the lysosome membrane to efficiently release the guest molecules from the lysosomes to the cytoplasm.
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http://dx.doi.org/10.1021/acs.langmuir.8b00632DOI Listing
February 2019

Hydrophobic Polyampholytes and Nonfreezing Cold Temperature Stimulate Internalization of Au Nanoparticles to Zwitterionic Liposomes.

Langmuir 2019 02 6;35(5):1740-1748. Epub 2018 Jul 6.

School of Materials Science , Japan Advanced Institute of Science and Technology , Nomi , Ishikawa 923-1292 , Japan.

Nanomedicine relies on the effective internalization of nanoparticles combined with polymeric nanocarriers into living cells. Thus, exploration of internalization is essential for improving the efficacy of nanoparticle-based strategies in clinical practice. Here, we investigated the physicochemical internalization of gold nanoparticles (AuNPs) conjugated with hydrophobic polyampholytes into cell-sized liposomes at a low but nonfrozen temperature. The hydrophobic polyampholytes localized in the disordered phase of the membrane, and internalization of AuNPs was enhanced in the presence of hydrophobic polyampholytes together with incubation at -3 °C as compared to 25 °C. These results contribute toward a mechanistic understanding for developing a model nanomaterials-driven delivery system based on hydrophobic polyampholytes and low temperature.
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http://dx.doi.org/10.1021/acs.langmuir.8b00920DOI Listing
February 2019

Comparative analysis of the cellular entry of polystyrene and gold nanoparticles using the freeze concentration method.

Biomater Sci 2018 Jun;6(7):1791-1799

School of Materials Science, Japan Advanced Institute of Science and Technology, Nomi, Ishikawa 923-1292, Japan.

Despite advances in nanoparticle delivery, established physical approaches, such as electroporation and sonication, result in cell damage, limiting their practical applications. In this study, we proposed a unique freeze concentration-based technique and evaluated the efficacy of the method using two types of nanoparticles: citrate-capped gold nanoparticles and carboxylated polystyrene nanoparticles. We further compared the internalisation behaviour of particles of various sizes with and without freezing. Confocal microscopic images showed that the uptake efficacy of 50 nm nanomaterials was greater than that of 100 nm particles. Polystyrene nanoparticles of 50 nm size had more favourable adsorption and internalisation behaviours compared to those of gold nanoparticles after freeze concentration. We also examined the possible endocytic pathways involved in the uptake of gold and polystyrene nanoparticles, and found that the route differed between non-frozen and frozen conditions. Overall, we determined the influence of the freeze concentration strategy on both nanomaterial internalisation and the endocytic uptake pathway. Our findings provide a mechanistic understanding of the internalisation of nanoparticles using a freezing approach and thereby contribute to further developments in nanotherapeutic applications.
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http://dx.doi.org/10.1039/c8bm00206aDOI Listing
June 2018

Enhanced Adsorption of a Protein-Nanocarrier Complex onto Cell Membranes through a High Freeze Concentration by a Polyampholyte Cryoprotectant.

Langmuir 2018 02 5;34(6):2352-2362. Epub 2018 Feb 5.

School of Materials Science, Japan Advanced Institute of Science and Technology , Nomi, Ishikawa 923-1292, Japan.

The transportation of biomolecules into cells is of great importance in tissue engineering and as stimulation for antitumor immune cells. Previous freezing strategies at ultracold temperatures (-80 °C) used for intracellular transportation exhibit certain limitations such as extended time requirements and harsh delivery system conditions. Thus, the need remains to develop simplified methods for safe nanomaterial delivery. Here, we demonstrated a unique strategy based on the ice-crystallization-induced freeze concentration for protein intracellular delivery in combination with a polyampholyte cryoprotectant. We found that upon sustained lowering of the temperature from -6 to -20 °C over a short duration, the adsorption of proteins onto the peripheral cell membrane was markedly increased through the facile ice-crystallization-induced freeze concentration. Furthermore, we proposed a freeze concentration factor (α) that depends on the freezing-point depression and is estimated from an analysis of the fraction of frozen water. Notably, the α values of the polyampholyte cryoprotectant were 8-fold higher than those of the currently used cryoprotectant dimethyl sulfoxide (DMSO) at particular temperatures of interest. Our results illustrate that the presence of a polyampholyte cryoprotectant significantly enhanced the adsorption of the protein/nanocarrier complex onto membranes compared to that obtained with DMSO because of the high freeze concentration. The present study demonstrated the direct relationship between freezing and the penetration of proteins across the periphery of the cell membrane by means of increased concentration during freezing. These results may be useful in providing a guideline for the intracellular delivery of biomacromolecules using ice-crystallization-induced continuous freezing combined with polyampholyte cryoprotectants.
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http://dx.doi.org/10.1021/acs.langmuir.7b03622DOI Listing
February 2018

Freezing-Assisted Gene Delivery Combined with Polyampholyte Nanocarriers.

ACS Biomater Sci Eng 2017 Aug 10;3(8):1677-1689. Epub 2017 Jul 10.

School of Materials Science, Japan Advanced Institute of Science and Technology, Nomi, Ishikawa 923-1292, Japan.

Physical methodologies such as electroporation and the gene-gun technology have been widely used for transfection; however, their applicability is limited because they lead to cell damage and low cell viability. Therefore, to address these limitations we developed a new freeze concentration-based gene transfection system that provides enhanced in vitro gene delivery compared to that provided by the commercially available systems. The system employs a facile freeze concentration step, whereby cells are simply frozen to very low temperatures in the presence of polymer-pDNA complexes. As part of system development, we also synthesized a low toxicity polyethylenimine (PEI)-based polyampholyte prepared through succinylation with butylsuccinic anhydride. In aqueous solution, this modified polyampholyte self-assembles to form small (20 nm diameter), positively charged (net surface charge of 35 mV), nanoparticles through a combination of hydrophobic and electrostatic interactions. Agarose gel electrophoresis analysis indicated that the polyampholyte nanoparticle was able to form a complex with pDNA that provided stability against nuclease degradation. Using transfection of HEK-293T cells, we demonstrated that a combination of polyampholyte: pDNA, at an appropriate ratio, and the freeze concentration method resulted in significant enhancement of GFP and luciferase expression compared to commercially available carriers. Endosomal escape of pDNA was also found to be increased when using the modified polyampholyte compared to branched PEI. This study suggests that the efficient combination of freeze concentration and the modified polyampholyte described here has great potential for in vitro gene therapy.
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http://dx.doi.org/10.1021/acsbiomaterials.7b00176DOI Listing
August 2017

A Freeze-Concentration and Polyampholyte-Modified Liposome-Based Antigen-Delivery System for Effective Immunotherapy.

Adv Healthc Mater 2017 Jul 11;6(14). Epub 2017 May 11.

School of Materials Science, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa, 923-1292, Japan.

Immunotherapy is an exciting new approach to cancer treatment. The development of a novel freeze-concentration method is described that could be applicable in immunotherapy. The method involves freezing cells in the presence of pH-sensitive, polyampholyte-modified liposomes with encapsulated ovalbumin (OVA) as the antigen. In RAW 264.7 cells, compared to unfrozen, freeze-concentration of polyampholyte-modified liposomes encapsulating OVA resulted in efficient OVA uptake and also allowed its delivery to the cytosol. Efficient delivery of OVA to the cytosol was shown to be partly due to the pH-dependence of the polyampholyte-modified liposomes. Cytosolic OVA delivery also resulted in significant up-regulation of the major histocompatibility complex class I pathway through cross-stimulation, as well as an increase in the release of IL-1β, IL-6, and TNF-α. The results demonstrate that the combination of a simple freeze-concentration method and polyampholyte-modified liposomes might be useful in future immunotherapy applications.
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http://dx.doi.org/10.1002/adhm.201700207DOI Listing
July 2017

Pneumococcal Serotype 5 Colonization Prevalence Among Newly Arrived Unaccompanied Children 1 Year After an Outbreak-Texas, 2015.

Pediatr Infect Dis J 2017 02;36(2):236-238

From the *Epidemic Intelligence Service and †Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; ‡Office of Refugee Resettlement, Administration for Children and Families, Washington, DC; §US-Mexico Unit, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention and Epidemiology and Immunization Services Branch, County of San Diego Health and Human Services Agency, San Diego, CA; ¶Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; and ‖Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, San Diego, California.

In 2014, an acute respiratory illness outbreak affected unaccompanied children from Central America entering the United States; 9% of 774 surveyed children were colonized with Streptococcus pneumoniae serotype 5. In our 2015 follow-up survey of 475 children, serotype 5 was not detected, and an interim recommendation to administer 13-valent pneumococcal conjugate vaccine to all unaccompanied children was discontinued.
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http://dx.doi.org/10.1097/INF.0000000000001398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742860PMC
February 2017

Using Maintenance of Certification as a Tool to Improve the Delivery of Confidential Care for Adolescent Patients.

J Pediatr Adolesc Gynecol 2017 Feb 16;30(1):76-81. Epub 2016 Aug 16.

Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.

Study Objective: Providing adolescents with confidential health care results in better social and health outcomes. We sought to assess if a medical board Maintenance of Certification Part IV project could improve the delivery of confidential care to minor adolescent patients seen in outpatient primary care practices.

Design: Participating physicians reviewed 3 months of charts for patients ages 12-17 years seen for well visits during a baseline time period, and after 2 Plan, Do, Study, Act intervention cycles to assess if they had met confidentiality standards. Participating physicians additionally completed an assessment tool on personal and clinic practices related to confidentiality.

Setting: Nine academic and 3 private practice family medicine, pediatrics, and medicine-pediatrics sites.

Participants: Forty-four physicians.

Interventions: Provider and staff deficits in knowledge of minor consent laws, resistance toward the idea of confidential care, and work flow issues around confidential screening were identified as primary barriers. Staff and provider trainings, scripts, and staff involvement in planning work flows were identified as key interventions.

Main Outcome Measures: Improvement in confidentiality standards met during minor adolescent well visits.

Results: Participating physicians significantly increased the proportion of well visits in which they spent time alone with the patient (P = .001), explained minor consent laws (P < .001), and had the adolescent complete a confidential risk screening tool (P < .001), in addition to improving scores on their confidentiality assessment overall (P < .001).

Conclusions: A medical board Maintenance of Certification Part IV project is an effective way to change physician practice and improve the delivery of confidential care to minor adolescents seen for well visits.
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http://dx.doi.org/10.1016/j.jpag.2016.08.006DOI Listing
February 2017

Reviewing a Manuscript: Disparity Amongst Peer Reviewers' Priorities from Basic Health Sciences and Clinicians.

J Coll Physicians Surg Pak 2016 Aug;26(8):677-80

Lecturer, Basic Health Sciences, Ziauddin University, Karachi.

Objective: To determine the disparities and the priorities of basic health scientists and clinicians while assessing a manuscript.

Study Design: Cross-sectional study.

Place And Duration Of Study: The study was conducted at Karachi, from January to April 2014.

Methodology: The study was a proforma-based research, employed convenient sampling for data collection, in which 100 reviewers belonging to clinical and basic health science background were selected. The questionnaire used was a selfadministered one with close-ended questions. The results were analysed using SPSS software.

Results: Out of 100 respondents, 50 were from Basic Health Sciences Reviewers (BRs) and 50 Clinicians Reviewers (CRs). The results depicted grammatical and improper referencing amongst formatting mistakes as the most common observation by the reviewers. The reviewers also raised concerns regarding validity of statistical analysis, use of outdated references and lack of acknowledgment of the sources of funding utilised by the authors. There were elements of manuscripts that BRs and CRs reviewers agreed upon and prioritised, but there were elements of the manuscript that they approached mostly in methods, results and conclusion components.

Conclusion: The priorities of reviewers from Basic Health Sciences and Clinical background differed markedly in certain respects. This impacts how they review the manuscripts.
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http://dx.doi.org/2403DOI Listing
August 2016

Enhanced protein internalization and efficient endosomal escape using polyampholyte-modified liposomes and freeze concentration.

Nanoscale 2016 Sep 21;8(35):15888-901. Epub 2016 Jul 21.

School of Materials Science, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa 923-1292, Japan.

Here we show a new strategy for efficient freeze concentration-mediated cytoplasmic delivery of proteins, obtained via the endosomal escape property of polyampholyte-modified liposomes. The freeze concentration method successfully induces the efficient internalization of proteins simply by freezing cells with protein and nanocarrier complexes. However, the mechanism of protein internalization remains unclear. Here, we designed a novel protein delivery carrier by modifying liposomes through incorporating hydrophobic polyampholytes therein. These complexes were characterized for particle size, encapsulation efficiency, and cytotoxicity. Flow cytometry and microscopic analysis showed that the adsorption and internalization of protein-loaded polyampholyte-modified liposomes after freezing were enhanced compared with that observed in unfrozen complexes. Inhibition studies demonstrated that the internalization mechanism differs between unmodified and polyampholyte-modified liposomes. Furthermore, polyampholyte-modified liposomes exhibited high efficacy in facilitating endosomal escape to enhance protein delivery to the cytoplasm with low toxicity. These results strongly suggest that the freeze concentration-based strategy could be widely utilised for efficient cargo delivery into the cytoplasm in vitro not only in cancer treatment but also for gene therapy as well.
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http://dx.doi.org/10.1039/c6nr03940eDOI Listing
September 2016

Common Questions About Oppositional Defiant Disorder.

Am Fam Physician 2016 Apr;93(7):586-91

University of Michigan Medical School, Ann Arbor, MI, USA.

Oppositional defiant disorder (ODD) is a disruptive behavior disorder characterized by a pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness lasting for at least six months. Children and adolescents with ODD may have trouble controlling their temper and are often disobedient and defiant toward others. There are no tools specifically designed for diagnosing ODD, but multiple questionnaires can aid in diagnosis while assessing for other psychiatric conditions. ODD is often comorbid with attention-deficit/hyperactivity disorder, conduct disorder, and mood disorders, including anxiety and depression. Behavioral therapy for the child and family members improves symptoms of ODD. Medications are not recommended as first-line treatment for ODD; however, treatment of comorbid mental health conditions with medications often improves ODD symptoms. Adults and adolescents with a history of ODD have a greater than 90% chance of being diagnosed with another mental illness in their lifetime. They are at high risk of developing social and emotional problems as adults, including suicide and substance use disorders. Early intervention seeks to prevent the development of conduct disorder, substance abuse, and delinquency that can cause lifelong social, occupational, and academic impairments.
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April 2016

Physician Knowledge and Attitudes around Confidential Care for Minor Patients.

J Pediatr Adolesc Gynecol 2015 Aug 17;28(4):234-9. Epub 2014 Aug 17.

Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.

Study Objective: Minor adolescent patients have a legal right to access certain medical services confidentially without parental consent or notification. We sought to assess physicians' knowledge of these laws, attitudes around the provision of confidential care to minors, and barriers to providing confidential care.

Design: An anonymous online survey was sent to physicians in the Departments of Family Medicine, Internal Medicine-Pediatrics, Obstetrics/Gynecology, and Pediatrics at the University of Michigan.

Results: Response rate was 40% (259/650). The majority of physicians felt comfortable addressing sexual health, mental health, and substance use with adolescent patients. On average, physicians answered just over half of the legal knowledge questions correctly (mean 56.6% ± 16.7%). The majority of physicians approved of laws allowing minors to consent for confidential care (90.8% ± 1.7% approval), while substantially fewer (45.1% ± 4.5%) approved of laws allowing parental notification of this care at the physician's discretion. Most physicians agreed that assured access to confidential care should be a right for adolescents. After taking the survey most physicians (76.6%) felt they needed additional training on confidentiality laws. The provision of confidential care to minors was perceived to be most inhibited by insurance issues, parental concerns/relationships with the family, and issues with the electronic medical record.

Conclusions: Physicians are comfortable discussing sensitive issues with adolescents and generally approve of minor consent laws, but lack knowledge about what services a minor can access confidentially. Further research is needed to assess best methods to educate physicians about minors' legal rights to confidential healthcare services.
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http://dx.doi.org/10.1016/j.jpag.2014.08.008DOI Listing
August 2015

Qualitative and quantitative evaluation of solvent systems for countercurrent separation.

J Chromatogr A 2015 Jan 4;1377:55-63. Epub 2014 Dec 4.

Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL 60612, USA; Institute for Tuberculosis Research, College of Pharmacy, University of Illinois at Chicago, 833 S. Wood Street, Chicago, IL 60612, USA.

Rational solvent system selection for countercurrent chromatography and centrifugal partition chromatography technology (collectively known as countercurrent separation) studies continues to be a scientific challenge as the fundamental questions of comparing polarity range and selectivity within a solvent system family and between putative orthogonal solvent systems remain unanswered. The current emphasis on metabolomic investigations and analysis of complex mixtures necessitates the use of successive orthogonal countercurrent separation (CS) steps as part of complex fractionation protocols. Addressing the broad range of metabolite polarities demands development of new CS solvent systems with appropriate composition, polarity (π), selectivity (σ), and suitability. In this study, a mixture of twenty commercially available natural products, called the GUESSmix, was utilized to evaluate both solvent system polarity and selectively characteristics. Comparisons of GUESSmix analyte partition coefficient (K) values give rise to a measure of solvent system polarity range called the GUESSmix polarity index (GUPI). Solvatochromic dye and electrical permittivity measurements were also evaluated in quantitatively assessing solvent system polarity. The relative selectivity of solvent systems were evaluated with the GUESSmix by calculating the pairwise resolution (αip), the number of analytes found in the sweet spot (Nsw), and the pairwise resolution of those sweet spot analytes (αsw). The combination of these parameters allowed for both intra- and inter-family comparison of solvent system selectivity. Finally, 2-dimensional reciprocal shifted symmetry plots (ReSS(2)) were created to visually compare both the polarities and selectivities of solvent system pairs. This study helps to pave the way to the development of new solvent systems that are amenable to successive orthogonal CS protocols employed in metabolomic studies.
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http://dx.doi.org/10.1016/j.chroma.2014.11.085DOI Listing
January 2015

Relationships between Personality Traits, Medial Temporal Lobe Atrophy, and White Matter Lesion in Subjects Suffering from Mild Cognitive Impairment.

Front Aging Neurosci 2014 29;6:195. Epub 2014 Jul 29.

UMRS 894 INSERM, Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité , Paris , France.

Mild cognitive impairment (MCI) is a heterogeneous cognitive status that can be a prodromal stage of Alzheimer's disease (AD). It is particularly relevant to focus on prodromal stages of AD such as MCI, because patho-physiological abnormalities of AD start years before the dementia stage. Medial temporal lobe (MTL) atrophy resulting from AD lesions and cerebrovascular lesions [i.e., white matter lesions (WML), lacunar strokes, and strokes] are often revealed concurrently on magnetic resonance imaging (MRI) in MCI subjects. Personality changes have been reported to be associated with MCI status and early AD. More specifically, an increase in neuroticism and a decrease in conscientiousness have been reported, suggesting that higher and lower scores, respectively, in neuroticism and conscientiousness are associated with an increased risk of developing the disease. However, personality changes have not been studied concomitantly with pathological structural brain alterations detected on MRI in patients suffering from MCI. Therefore, the objective of the present study was to assess the relationship between MTL atrophy, WML, lacunar strokes, and personality traits in such patients. The severity of WML was strongly associated with lower levels of conscientiousness and higher levels of neuroticism. Conversely, no association was detected between personality traits and the presence of lacunar strokes or MTL atrophy. Altogether, these results strongly suggest that personality changes occurring in a MCI population, at high risk of AD, are associated with WML, which can induce executive dysfunctions, rather than with MTL atrophy.
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http://dx.doi.org/10.3389/fnagi.2014.00195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114211PMC
August 2014

Senescence related alteration in hippocampal biogenic amines produces neuropsychological deficits in rats.

Pak J Pharm Sci 2014 Jul;27(4):837-45

Neurochemistry and Biochemical Neuropharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi, Pakistan.

Aging is a natural complex process that is regulated at genetic, cellular, molecular and systemic levels and leads to the development of a variety of changes including structural, chemical and genetic in the senescent brain. The major goal of the present study was to investigate the age associated cognitive dysfunction and other behavioral changes and their association with age related alterations in levels of neurotransmitters, such as dopamine (DA) and serotonin (5-HT) in the hippocampal region. Twelve male Albino Wistar rats were taken for the study including six young rats (04-05 months old) and six aged (20-22 months old) rats in each group. The learning and memory performance of rats was assessed by passive avoidance test (PA) and novel objective recognition task (NOR). Ambulatory activity was monitored by Open field test. Light/Dark transition test was used to monitor anxiety, whereas depression like symptoms was examined by Forced Swim Test (FST). Results showed that aged rats exhibited learning and memory impairment in PA and NOR. There was a negative relation between aging process and locomotion, consistent with previous findings. Moreover, an augmented increase in level of anxiety and depression was also observed in senescent rats. A marked decrease in DA and 5-HT was observed in the hippocampus of aged rats. Similarly, levels of 5-HIAA and DOPAC were also found to be decreased in aged rats. It is therefore concluded that age has a negative influence on cognitive function, depression, anxiety and locomotion in rats. Cells in all brain regions, especially hippocampus are affected by aging. In general aging exhibits a decline in sensory, motor and cognitive functions. These behavioral changes or functional deficits may be attributed to the age related decline in the levels of different neurotransmitters in brain/hippocampus. The present findings of behavioral deficits and altered neurotransmission in hippocampus of aged rats suggest a relationship between senescence, altered brain neurotransmitters and behavioral deficits.
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July 2014

Protein cytoplasmic delivery using polyampholyte nanoparticles and freeze concentration.

Biomaterials 2014 Aug 10;35(24):6508-18. Epub 2014 May 10.

School of Materials Science, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi, Ishikawa 923-1292, Japan. Electronic address:

A protein delivery method using freeze concentration was presented with a variety of polyampholyte nanocarriers. In order to develop protein nanocarriers, hydrophobically modified polyampholytes were synthesized by the succinylation of ε-poly-l-lysine with dodecyl succinic anhydride and succinic anhydride. The self-assembled polyampholyte aggregated form nanoparticles through intermolecular hydrophobic and electrostatic interactions when dissolved in aqueous media. The cationic and anionic nanoparticles were easily prepared by changing the succinylation ratio. Anionic or cationic proteins were adsorbed on/into the nanoparticles depending on their surface charges. The protein-loaded nanoparticles were stable for at least 7 d. When L929 cells were frozen with the protein-loaded nanoparticles in the presence of a cryoprotectant, the adsorption of the protein-loaded nanoparticles was enhanced and can be explained by the freeze concentration mechanism. After thawing, proteins were internalized into cells via endocytosis. This was the first report that showed that the efficacy of protein delivery was successfully enhanced by the freeze concentration method. This method could be useful for in vitro cytoplasmic protein or peptide delivery to various cells for immunotherapy or phenotype transformations.
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http://dx.doi.org/10.1016/j.biomaterials.2014.04.030DOI Listing
August 2014

Engaging general practitioners in public-private mix tuberculosis DOTS program in an urban area in Pakistan: need for context-specific approach.

Asia Pac J Public Health 2015 03 9;27(2):NP984-92. Epub 2013 Apr 9.

Aga Khan University, Karachi, Pakistan

A public-private mix tuberculosis (TB) DOTS project was implemented to enhance coverage and collaboration between the public and private sectors, with an objective to increase case detection and to improve TB case management in a large urban area. General practitioners (GPs) were trained to provide DOTS services. Patients were diagnosed and treated as per national guidelines and outcomes were reported to national TB control program. Treatment and sputum microscopy were provided free of cost. A total of 94 GPs were trained. In all, 57.4% of trained GPs remained actively involved in the project. Overall treatment success rate of the patients enrolled with the project was 86.3% with 8.7% default patients. Experience suggests that a more stringent selection criteria need to be followed for inclusion of GPs in the program to improve the success of the program. A multifaceted context specific approach is needed while working with private health care providers.
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http://dx.doi.org/10.1177/1010539513483828DOI Listing
March 2015

Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae: a multihospital study.

Infect Control Hosp Epidemiol 2012 Dec 25;33(12):1193-9. Epub 2012 Oct 25.

Rush University Medical Center, Chicago, Illinois, USA.

Objective: To determine whether transfer from a long-term care facility (LTCF) is a risk factor for colonization with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae upon acute care hospital admission.

Design: Microbiologic survey and nested case-control study.

Setting: Four hospitals in a metropolitan area (Chicago) with an early KPC epidemic.

Patients: Hospitalized adults.

Methods: Patients transferred from LTCFs were matched 1∶1 to patients admitted from the community by age (± 10 years), admitting clinical service, and admission date (± 2 weeks). Rectal swab specimens were collected within 3 days after admission and tested for KPC-producing Enterobacteriaceae. Demographic and clinical information was extracted from medical records.

Results: One hundred eighty patients from LTCFs were matched to 180 community patients. KPC-producing Enterobacteriaceae colonization was detected in 15 (8.3%) of the LTCF patients and 0 (0%) of the community patients ([Formula: see text]). Prevalence of carriage differed by LTCF subtype: 2 of 135 (1.5%) patients from skilled nursing facilities without ventilator care (SNFs) were colonized upon admission, compared to 9 of 33 (27.3%) patients from skilled nursing facilities with ventilator care (VSNFs) and 4 of 12 (33.3%) patients from long-term acute care hospitals (LTACHs; [Formula: see text]). In a multivariable logistic regression model adjusted for a propensity score that predicted LTCF subtype, patients admitted from VSNFs or LTACHs had 7.0-fold greater odds of colonization (ie, odds ratio; 95% confidence interval, 1.3-42; [Formula: see text]) with KPC-producing Enterobacteriaceae than patients from an SNF.

Conclusions: Patients admitted to acute care hospitals from high-acuity LTCFs (ie, VSNFs and LTACHs) were more likely to be colonized with KPC-producing Enterobacteriaceae than were patients admitted from the community. Identification of healthcare facilities with a high prevalence of colonized patients presents an opportunity for focused interventions that may aid regional control efforts.
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http://dx.doi.org/10.1086/668435DOI Listing
December 2012

A comprehensive review of hypertension in pregnancy.

J Pregnancy 2012 23;2012:105918. Epub 2012 May 23.

Division of Nephrology, Department of Medicine, State University of New York at Buffalo, Buffalo, NY 14215, USA.

Hypertension is the most common medical disorder encountered during pregnancy. Hypertensive disorders are one of the major causes of pregnancy-related maternal deaths in the United States. We will present a comprehensive update of the literature pertinent to hypertension in pregnancy. The paper begins by defining and classifying hypertensive disorders in pregnancy. The normal vascular and renal physiological changes which occur during pregnancy are detailed. We will summarize the intriguing aspects of pathophysiology of preeclampsia, emphasizing on recent advances in this field. The existing diagnostic tools and the tests which have been proposed for screening preeclampsia are comprehensively described. We also highlight the short- and long-term implications of preeclampsia. Finally, we review the current management guidelines, goals of treatment and describe the potential risks and benefits associated with various antihypertensive drug classes. Preeclampsia still remains an enigma, and the present management focuses on monitoring and treatment of its manifestations. We are hopeful that this in depth critique will stimulate the blossoming research in the field and assist practitioners to identify women at risk and more effectively treat affected individuals.
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http://dx.doi.org/10.1155/2012/105918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366228PMC
June 2013

Feasibility and acceptability of a 1-page tool to help physicians assess and discuss obesity with parents of preschoolers.

Clin Pediatr (Phila) 2009 Nov 29;48(9):954-9. Epub 2009 May 29.

Pediatric Comprehensive Weight Management Center, University of Michigan, Ann Arbor, Michigan, USA.

Objective: To assess the feasibility and acceptability of a brief tool to help pediatricians communicate with parents of preschoolers about obesity risk, prevention, and treatment.

Methods: The 2-sided Assessment and Targeted Messages (ATM) tool developed by the investigators included sections to assess nutrition and physical activity, self-efficacy and readiness-to-change, obesity-related family history, and treatment/prevention recommendations. Twenty-five pediatricians were recruited to use the ATM and then surveyed regarding their opinions of its feasibility and acceptability.

Results: Response rate was 60%. Most ATM features were considered somewhat or very useful by the majority of respondents. The majority of physicians (62%) indicated that they were somewhat likely to use the ATM in the future, with only 23% indicating that they were very likely to use it. The greatest barrier to its use was time.

Conclusion: Pediatricians considered the ATM tool moderately feasible and acceptable. Time-efficient methods to help physicians address obesity should be explored.
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http://dx.doi.org/10.1177/0009922809338060DOI Listing
November 2009